Anesthesiologists are involved: Anesthesiologists are involved

leukotrienes, endothelin,

complement

interleukins

tumor necrosisfactor

and others

This why a patient may die of multiple organ failure after traumatic hemorrhage, even when bleeding has been controlled and the patient resuscitated to normal vital signs and perfusion.

• This why a patient may die of multiple organ failure after traumatic hemorrhage, even when bleeding has been controlled and the patient resuscitated to normal vital signs and perfusion.

• The CNS is the prime trigger of the neuroendocrine response to shock, which maintains perfusion to the heart, kidney, and brain at the expense of other tissues.

• Regional glucose uptake in the brain changes during shock.

• Reflex activity and cortical electrical activity are both depressed during hypotension; these changes are reversible with mild hypoperfusion but become permanent with prolonged ischemia.